МЕТHODOLOGICAL INSTRUCTION
FOR THE V-th YEAR STUDENTS
foreign students faculty
LESSON № 5 (6 hours)
Theme 5: Primary immunodeficiens. Secondary immunodeficiency. Curation 2
Aim: to form the complete picture of the immunologic anamnesis, structure of immunopathology, to beable verify primary and secondary immunodeficiency.
Professional motivation: immunologic diagnosis and strategy of therapy of immunopathology dependson the stage of immune homeostasis disorders. Sopossibility of immune analysis interpreting is necessaryfor every doctor.
Methodology of Practical Class
Introduction by the teacher, control the initial level of knowledge – 09.00-09.30
Individual students’ work with patients – 09.30-12.00
Break – 12.00-12.30
Seminar (discussion of theoretical questions, practical work with patients) – 12.30-14.00
Break – 14.00-14.15
Individual work 1415-1500 (students who didn`t pass the tests in Moodle system, complete the individual work).
Algorithm of students’ communication with patients with pathology in subject (communication skills):
During examination of the patient students have to use such communicative algorithm:
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Take complaints and anamnesis in a patient.
5. Explain to the patient results of his/her lab tests correctly and accessibly.
6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.
7. Conversation accomplishment.
Objective examination:
Physical methods of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient, what examinations will be carried out and get his/her informed consent.
5. Find a contact with the patient and make an attempt to gain his/her trust.
6. Inform about the possibility of appearing of unpleasant feelings during the examination.
7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).
8. Examination (demonstration of clinical skill).
9. Explain to the patient results of his/her lab tests correctly and accessibly.
10. Conversation accomplishment.
Estimation of laboratory and instrumental investigations
Informing about the results of examination of patients with internal diseases
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing.
4. Explain to a patient results of his/her lab tests correctly and clearly.
5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).
Planning and prognosis the results of the conservative treatment
Friendly facial expression and smile.
1. Gentle tone of speech.
2. Greeting and introducing.
3. Correct and clear explanation of necessary treatment directions.
4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.
5. Conversation accomplishment.
WORK 1: Curation of the patient with aquired immune deficiency.
WORK 2: Curation of the patient with primary immune deficiency.
WORK 3: Curation 2. Case history defence.
Individual Students Program
1. Cells and tissues of immune system.
2. Antibodies: structure and function.
3. Congenital and acquired immunity.
4. Cytokines: intracellular messengers of proliferation and function. Regulation of immune response.
5. The mucosal immune system.
6. Classification of the primary and secondary immune deficiency.
7. Diagnostic of the primary and secondary immune deficiency.
8. Treatment of the of the primary and secondary immune deficiency.
Seminar discussion of theoretical issues:
1. Congenital immunodeficiency disease: definition, classification, mechanisms of development.
2. Clinical signs, immune-diagnostics, treatment approaches: combined, T – i B – dependentimmunodeficiency, caused by disturbance immunity and phagocytic deficiency ofcomplement proteins.
3. Acquired immunodeficiency disease: definition, causes, mechanisms of development,classification, diagnostics.
4. Early detection in the the organism of secondary immunological insufficiency. Basicapproaches to treatment.
5. Rapid fatigue syndrome, chronic fatigue syndrome.
6. Etiology, immunopathogenesis, diagnostic and treatment of AIDS. Immunological methods of the diagnosis of AIDS. Immunoprophilaxis of HIV.
Test evaluation and situational tasks:
A. IL-7-induced B-cell activation and secretion of antibodies
B. IL-3-mediated B-cell activation and induction of help for T-cell activation
C. Monocyte-derived IL-6 activation of T cells
D. Complement-mediated endothelial cell damage
E. CD44-mediated monocyte adhesion to endothelial cells
respiratory infections and for a history of diarrhea 3 years ago due to Giardia lamblia infection. The mostappropriate therapy would be
A. corticosteroids
B. corticosteroids and an alkylating agent
C. monthly intravenous immunoglobulin
D. splenectomy
E. bone marrow transplantation
3. All of the following statements regarding the epidemiology of HIV infection are correct EXCEPT
A. the risk of transmission following skin puncture from a needle contaminated with blood from an HIVinfected
patient is less than 0.5 percent
B. most cases of AIDS are now among I/V drug users
C. the risk of transmission from a single donor unit of blood is approximately 1/500,000
D. most pediatric cases of AIDS arise because of vertical transmission from an infected mother
E. there is no convincing evidence that saliva can transmit HIV
4. Which of the following statements best describes the role of polymerase chain reaction (PCR) in thediagnosis of HIV infection?
A. It should be used if the western blot is indeterminate
B. It is a useful screening test
C. It should be used if two consecutive serologic tests (ELISA) are positive
D. It should be used if the initial serologic test is positive, but the second is negative
E. It has no real role
5. All the following statements concerning the ataxia-telangiectasia syndrome are correct EXCEPT
A. it is inherited in an autosomal recessive manner
B. the cause is adenosine deaminase deficiency
C. malignancy is a common cause of death
D. bronchiectasis may occur
E. both humoral and cellular limbs of the immune system are affected
6. Which of the following statements regarding central nervous system disease in patients with HIVinfection is correct?
A. The most common cause of central nervous system disease is the AIDS dementia complex
B. The most common cause of seizures is cryptococcal meningoencephalitis
C. Antiretroviral agents have no role
D. The most common finding on MRI is multiple white matter lesions
E. Actual histologic evidence of direct HIV involvement is rare
7. Which of the following is the LEAST common immunologic manifestation of HIV infection?
A. Cutaneous reactions to drugs
B. Anaphylactic reactions to drugs
C. Anticardiolipin antibodies
D. Oligoarticular arthritis
E. Fibromyalgia
8. Which histologic subtype of lymphoma occurs most commonly in patients infected with HIV?
A. Immunoblastic (large cell) lymphoma
B. Small, noncleaved (Burkitt’s) lymphoma
C. Small, cleaved (follicular) lymphoma
D. Primary central nervous system lymphoma
E. Hodgkin’s disease, mixed cellularity
electrophoresis, bone marrow aspirate and biopsy that discloses normal hematopoiesis and 3 percent bonemarrow plasma cells, and a negative skeletal survey. The proper course of action at this point is to
A. obtain quantitative immunoglobulin levels
B. obtain beta-microglobulin level
C. begin therapy with melphalan and prednisone
D. begin therapy with high-dose prednisone
E. reassure the patient; no additional action is required at this time
10. True statements about human T cells include which of the following?
A. They are the principal cells in the cortical “germinal centers” and medullary cords of lymph nodes
B. They carry membrane-bound IgD on their surface
C. They constitute 70 to 80 percent of circulating blood lymphocytes
D. They arise from stem cells in the thymus
E. They are the main effectors of antibodydependent, cell-mediated cytotoxicity
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks)
Students should know:
1. Cell and tissue of immune system.
2. Antibodies: structure and function.
3. Congenital and acquired immunity.
4. Classification of the primary and acquired immune deficiency.
5. Diagnostic of the primary and acquired immune deficiency.
6. Treatment of the of the primary and acquired immune deficiency.
Students should be able to:
1. Analyse of immune tests.
2. Find the criteria of PID and SID
3. Clinical features of PID and SID
4. Correct treatment of PID and SID
Correct answers of test evaluations and situational tasks:
А – Basic:
1. Stephen Holgate. Martin Church. David Broide Fernando
2. Mark Peakman. Diego Vergani. Basic and Clinical Immunology with STUDENT. – Imprint: Churchill Livingstone Published: – April 2009.
3. Roderick Nairn, Matthew Helbert. Immunology for medical students / Hardboun – 2012 –326 p.
4. Web -sites:
a) http://intranet.tdmu.edu.ua : Primary immunodeficiens. Secondary immunodeficiency
b) http://emedicine.medscape.com/
B – Additional:
1. Linda Cox. Allergen Immunotherapy, An Issue of Immunology and Allergy Clinics.- / Published: May 2011.- Hardbound, – 312 p.
2. Dédée Murrell. Autoimmune Diseases of the Skin, An Issue of Immunology and Allergy Clinics. – Imprint: Saunders.- Published: May 2012.
Methodical instruction has been worked out by assoc. prof. Volodymyr Horodetskyy
Methodical instruction was discussed and adopted at the Department sitting: “
